A comparative study on effect of evening versus morning intake of levothyroxine in patients of hypothyroidism

Sajjad Hossain, Manasi Banerjee, Shirsendu Mondal, Animesh Maiti

Thyroid Research and Practice 2018 15(2):89-93

Background: Levothyroxine sodium is widely prescribed to treat primary hypothyroidism. Conventionally, levothyroxine is asked to be taken in the morning on an empty stomach. A pilot study showed that levothyroxine intake at bedtime significantly decreased thyrotropin levels and increased free thyroxine (fT) and total triiodothyronine levels. Till date, no large randomized trial investigating the best time of levothyroxine intake, including quality-of-life evaluation has been performed. Materials and Methods: The primary objective of this study was to compare the serum thyroid stimulating hormone and fT4level between patients taking evening dose of levothyroxine with patients taking morning dose. The secondary objectives were to compare lipid profile between patients of the two groups. Results: A total of 147 patients were recruited and randomized into either of the study groups (73 in Group A and 72 in Group B). A total of 58 patients in Group A and 57 patients in Group B were considered for statistical evaluation. There was no statistical difference in achievement of euthyroidism and improvement of thyroid profile between the two groups. Changes in values of total cholesterol, triglyceride, low-density lipoprotein (LDL), very LDL and high-density lipoprotein were not significantly different between the groups. Conclusions: Levothyroxine taken at bedtime improved thyroid hormone level. Serum lipid levels showed no significant changes with bedtime versus morning intake. Clinicians may consider prescribing levothyroxine at bedtime as an alternative to the conventional morning dose.

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